Mental health conditions account for 12 percent of the disease burden and 31 percent of years lived with disability globally. A 18 percent increase has been recorded over the last decade.
Today, 350 million people suffer from depression with effects on work, socialisation, school and families. At its worst, depression can lead to suicide -800,000 people die from suicide annually. Depressed men are four times more likely to commit suicide than depressed women. The rising rates of suicide, murder and other crimes globally paint a troubling picture of how the society is today struggling with depression.
Depression is treatable with talking therapies, cognitive behavioural therapy, behavioural activation or antidepressant medication or a combination of these. However, less than 10 percent of patients in low and middle income countries, receive these treatments due to barriers such as cost of health, shortage of mental healthcare providers, low awareness, stigma and inaccurate diagnosis.
In many respects, men fare worse than women in health. One in eight men will experience depression at some stage of their lives, but it is underreported. Women are twice as likely as men to suffer from depression, but men are a numerical minority group when it comes to receiving diagnosis and treatment.
The classic presentation of depression is: deep sadness, lethargy, loss of interest in activities, change in appetite, sleeping disorders, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt, or hopelessness and thoughts of self-harm including suicide.
Men mask or deny these symptoms and are therefore more likely to experience “stealth” depression symptoms such as: mood fluctuations — feeling aggressive, hostile or irritable; reckless behaviours — fights, dangerous driving, drunk driving or gambling; drug abuse; isolation; and decreased libido.
Other commonly overlooked signs in men are: physical pain such as backache, headaches, insomnia, sexual dysfunction, or digestive disorders; anger, irritability, sensitivity to criticism, loss of sense of humour, short temper, violence and controlling tendencies; and other reckless behaviours such as pursuing dangerous sports, unsafe sex and compulsive gambling.
The causes are complex and diverse including biological (genetic) and personality factors, adverse life experiences and life stressors. Some of the triggers in men include: stress at work or home, relationship problems, health problems, family responsibilities, financial challenges, retirement and loss of independence, death of a loved one, poor coping skills, ageing in isolation, impotence or erectile dysfunction, alcohol or drug abuse and childhood trauma.
Masculinity plays an important role in depression-the society’s confusion over what defines masculinity creates unnecessary pressure on men. There is a perception that men should be tough, self-reliant and in control of their emotions. Boys hear these and other similar statements while growing up and internalise them. In their adulthood they struggle to find place in a society which expects them to be “real men’ but also be “emotionally sensitive”. These stereotypical notions along with the stigma associated with having mental illnesses make it difficult for depressed men to be identified or seek help. The ‘hidden curriculum’ that teaches that men are stronger than women and shouldn’t cry, show weakness or ask for help is therefore out of place in the modern world.
Early identification of depression in men can ensure that the condition is treated and they get back to their work, studies, family and hobbies.
Relatives, workmates and friends should help depressed men contact clinicians and ideally accompany them for such appointments. Other ways to help include: offering support and encouragement; never ignoring comments about suicide; joint physical and social activities; reporting any concerns about side effects of depression medication and; support for routine clinician’s appointments.
For depressed men, self-help steps include: seeking professional help; social support; “wellness toolbox”-eight hours of sleep, keeping stress in check and regaining control, relaxation techniques and exposure to sun to boost serotonin levels; exercising; healthy diet with low sugar and low refined carbs, reduced intake of caffeine, alcohol, trans fats, and foods with high levels of chemical preservatives or hormones, eat more Omega-3 fatty acids and other foods rich in mood-enhancing nutrients such as bananas and spinach and avoid deficiencies in B vitamins; pleasurable activities; and challenge negative thinking-remember thoughts are not facts.
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